Ever dealt with it and your reaction

[GassiusClay]

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So last night I was at a friend's place, and another guy who pretty much runs his daddy's sleep lab states that his "scorers" can read a report just as well as a pulm doc. Basically WTF? He says they just look at the score and make a diagnosis. That's like saying a cards doc looks at the perfusion defect score and neglects the rest of the findings to make an impression. What BS? How many of you have dealt with this? This whole I could even do it.

 

[Winged Scapula]

I run into this on a *daily* basis with radiology techs.

They know they aren't supposed to say things to patients, but I have had some techs who think they are the patient's primary physician, or at the very least a radiologist:

1) told a patient since the tech didn't see anything on the US, there was nothing there (ignoring the asymmetrical density on the mammogram)

2) told a patient that she had a breast "mass" but couldn't find anything on US; the patient had normal breast tissue (which I don't expect the tech to be an expert in a clinical physical exam but they shouldn't act like they are)

3) tell a patient that a solid mass is a cyst

4) tell a patient they weren't sure what they were biopsying (ok, if you don't know what you are supposed to be doing, don't do it and at the very least, don't tell the patient. Now the patient comes to me and tells me she doesn't think the radiologist and tech didn't know what they were doing. I agreed.)

5) tell the patient that they didn't see anything on the imaging so there was no need for any other testing until routine screening in a year (thanks, but I'll make that clinical judgement. Better yet, let me send you the pathology report of that patient's malignancy...the patient you told to wait a year for her next mammogram. Thank goodness she didn't.)

6) tell the patient that because they've never heard of a procedure (outside of their realm of specialty) that they weren't sure what it was for and probably didn't need to be done.

 

[Kubed]

Agreed, but equally frustrating to me are the ones who do this:

Me: See anything on the scan?

Tech: I'm not the Radiologist.

Me: I know, but you sit here all day looking at belly scans. You notice anything that seemed abnormal?

Tech: I'm not allowed to read scans.

Me: Dude, I'm asking you a simple casual question. I'm not asking for a formal read. I know you're not the Rad. I won't use your read to make a diagnosis. I always look at these things myself. I'm just asking if you saw anything because it's sitting in front of you, and you know that it will take 30min for it to get loaded on my computer, and another 2hrs for the Rad to get around to looking at it. So did you see anything that I should be freaking out about?

Tech: I'm not allowed to read scans.

I think the last one should have read like this:

Tech: "I'm not allowed to..ech...gah... GLA...EK!"

(roughly translated: "I'm not allowed to... wait, what are you doing!? Please take your hands away from my neck and stop choking me!"

 

[f_w]

I run into this on a *daily* basis with radiology techs.

They know they aren't supposed to say things to patients, but I have had some techs who think they are the patient's primary physician, or at the very least a radiologist:
.
.
.

I took over a radiology department where 'tech reporting' had gone unchecked for a long time. Your post sounds soo eerily familiar, almost like you came through here as a locum...

It required years of friendly reminders, then unfriendly reminders, then personnel file entries and if necessary firings to get everyone in compliance.

If this crap keeps happening, it requires some serious chewing out of a couple of people along the way. Particularly in breast and OB imaging, the techs are to keep their trap shut. The complications and liabilities from techs talking too much are just too great.

Giving prelimnary objective findings to referring services is different. Nothing wrong with the sonographer telling the ER doc or surgeon about free fluid, gallstones GB wall thickness presence of cardiac activity or other objective findings (this doesn't cover writing interpretations such as 'no ectopic' into a patients chart).

This also doesn't mean that techs should notifiy someone if they notice something that is gravely wrong. This week alone, I got called by MRI and CT techs about 2 patients with (unexpected) intracranial masses. Rather than sending them on their merry way, leaving it to the ordering PCPs to track them down and tuck them in with neurosurg, they where kept in the waiting room and could be dispo'ed from there.

[rant]
The whole sleep lab business is a part of the 'pulmonary industrical complex' that is very adept at leeching off the medicare program without necessarily contributing to the overall health of the population. (the sleep lab generates the OSA patients that turn into long-term cash-cows for the next steps in the food chain, the durable medical goods and home oxygen suppliers).
[/rant]

 

[group_theory]

I took over a radiology department where 'tech reporting' had gone unchecked for a long time. Your post sounds soo eerily familiar, almost like you came through here as a locum...

It required years of friendly reminders, then unfriendly reminders, then personnel file entries and if necessary firings to get everyone in compliance.

If this crap keeps happening, it requires some serious chewing out of a couple of people along the way. Particularly in breast and OB imaging, the techs are to keep their trap shut. The complications and liabilities from techs talking too much are just too great.

When I was a student, I rotated through a hospital where techs giving their prelim findings to patients was a long-standing tradition that the radiologists and many surgeons were fighting. Finally one day an email was sent (don't remember which department in the hospital) basically reminding the staff that their names are listed on reports (as the one performing it) and if a tech were to give the patient wrong information, he/she can be easily named in a lawsuit. The email went on to state that giving prelim reads to patient is not part of their training nor part of their job description so the hospital will not provide any relief should the tech be sued for his/her actions.

In reality I don't know how much liability would fall upon the tech but the fear of such possibility solved this issue. Unfortunately the consequence will be what happened at Tired's hospital - where techs are very by-the-book.

 

[f_w]

The email went on to state that giving prelim reads to patient is not part of their training nor part of their job description so the hospital will not provide any relief should the tech be sued for his/her actions.

Plaintiffs attorneys are looking for the 'deep pocket'. In imaging, that is the hospital. The tech is an employee of the hospital so the hospital is liable for their actions, whether they try to abrogate that responsibility in a mass distribution email or not (it would be the hospital named in the suit, not the tech personally).

If the tech only puts objective findings and measurements in their notes, pretty much all the liability for an incorrect US report falls on the radiologist. If the tech puts a diagnosis on the chart, they expose the hospital to liability for that incorrect diagnosis.

The bigger liability problem is the risk of delivering 'mixed messages' to the patient (how come I need a breast biopsy if ultrasound didn't show anything ?)

Unfortunately the consequence will be what happened at Tired's hospital - where techs are very by-the-book.

That tech did exactly what is expected from him/her and I would get anyones a$$ fired if they threatened my staff with violence to get prelim findings (if there is something to 'freak out' about, a good tech will bring the study to the radiologists attention who can then ensure that the correct findings are communicated to whoever is responsible for the patients care at that point).

 

[michaelrack]

So last night I was at a friend's place, and another guy who pretty much runs his daddy's sleep lab states that his "scorers" can read a report just as well as a pulm doc.

You might get more discussion of your question (rather than radiology techs) by posting this in the sleep medicine forum.

My technicians are good, but they can't "read" a sleep study at anywhere close to my level of competence. However, I am a board certified sleep specialist (through the American Board of Internal Medicine) and not a pulmonologist. There are probably many sleep techs who can read studies better than pulmonologists who aren't board certified sleep specialists (just as some rad techs may be better at reading some x-ray studies than non-radiologist physicians).

 

[f_w]

What a crock. If your techs can't bring something to my attention (you know, me, the MD who ordered the damn study in the first place) then why are you okay with them bringing it to the Rads attention (you know, the Radiologist who sits in a dark room and has no power to help the patient)?

Sounds like typical Radiology power tripping.

If you can look at the US images in conjunction with the tech notes and arrive at a diagnosis yourself, sure be my guest. If you need the tech to interpret the study for you, you have no right to expect any other answer than the one given.

 

[f_w]

But if I have a patient in the basement who just got their head scanned for altered mental status, it would be nice to have a tech answer me when I say, "Did you see a bunch of blood in the ventricles?" Not that I'll take their word for it, of course, but it's good to get an early heads up in the 30min it takes for the scan to load into the PACS system.

There must be something wrong with the workflow at your hospital. 30 min is maybe an acceptable turn-around for a report, certainly not an acceptable timeframe to get the study available on PACS (on my system studies are uploaded as they are scanned, so even if the tech does reconstruction work, the source images are available as soon as the scanner spits them out). If there are undue delays in getting prelim reports from the rads residents, address the issue with their program director. Don't try to fix it by trying to extract a report out of someone with a 2 years associate and some on the job training.

If you 'don't take their word for it', their report is going to be useless to you.

 

[group_theory]

Plaintiffs attorneys are looking for the 'deep pocket'. In imaging, that is the hospital. The tech is an employee of the hospital so the hospital is liable for their actions, whether they try to abrogate that responsibility in a mass distribution email or not (it would be the hospital named in the suit, not the tech personally).

If the tech only puts objective findings and measurements in their notes, pretty much all the liability for an incorrect US report falls on the radiologist. If the tech puts a diagnosis on the chart, they expose the hospital to liability for that incorrect diagnosis.

The bigger liability problem is the risk of delivering 'mixed messages' to the patient (how come I need a breast biopsy if ultrasound didn't show anything ?)

Actually I agree. The hospital would be liable and the techs might not even be named. But it was the fear of being named in the suit that got people to finally change their habits.

 

[EM_Rebuilder]

So last night I was at a friend's place, and another guy who pretty much runs his daddy's sleep lab states that his "scorers" can read a report just as well as a pulm doc. Basically WTF? He says they just look at the score and make a diagnosis. That's like saying a cards doc looks at the perfusion defect score and neglects the rest of the findings to make an impression. What BS? How many of you have dealt with this? This whole I could even do it.

All doctors have to deal with this, near daily. I think the best thing to do is keep your mouth shut and move on...being humble in medicine goes a LONG way.....that at least is the professional way to go about such comments.

The issues with rad techs or other techs mentioning TMI to patients should be brought up with their superiors so that it can be corrected. That is unprofessional, hinders medical care, and not something we should tolerate. If it is a tech in your particular dept that you know or work with closely, I would certainly be for talking to them directly and keeping superiors out of it the first time it happens....so often these techs have high turnovers and little association so I rarely figure out who any of them are.

 

[roja]

[And as a side note, no test can make a diagnosis in the absence of clinical correlation. We make fun of the Radiologists a lot for their ever-present "clinical correlation required", but it's absolutely true.]

 

[roja]

Sorry, I don't accept kudos from the ED set.

You know darn well I hate all of you.

Your acceptance isn't necessary, as its an applaud-able point regardless of if you accept the kudos or not, or your deep seated love of EM folks. (The sic gentleman doth protest too much, methinks. 😀)

 

[dpmd]

There must be something wrong with the workflow at your hospital. 30 min is maybe an acceptable turn-around for a report, certainly not an acceptable timeframe to get the study available on PACS

I think I would fall down dead if I got a report on any kind of radiology study at my institution within 30 minutes. The way they read stuff here is absurd. We are not digital yet, so there are multiple places with the scrolling type film view boxes. The rads sit there and read what is on the board, then the file room people take that board down while the rads goes for coffee, lunch, or a masturbation break for all I know. It takes about 30 minutes for the CT films to print unless there are recons-then you might as well go for a break of your own. If I have a patient that I am really worried about having something I will go with the to the scanner and watch it on the screen as it is done, but otherwise our techs will routinely call us if they see anything screwy. I don't see why that would be a bad thing. We don't have any radiologists at night, and coverage on weekends is sparse, so calling them is not an option. I agree that it can help you make the decision to run down and check things out, versus take care of one of the twenty other things you are trying to get done while you wait for the film to make it to the file room. Granted a tech just out of school would probably be worthless, but how long did it take you to figure out what you were looking at on various studies? Why wouldn't someone who is looking at that type of study all day for years pick up some knowledge that would be helpful to the clinician?

 

[f_w]

I think .................. would be helpful to the clinician?

From your post I gather that there IS indeed a lot wrong with the workflow and staffing levels at your hospital.

 

[dpmd]

From your post I gather that there IS indeed a lot wrong with the workflow and staffing levels at your hospital.

Yeah. We get good at reading films pretty fast here (at least in surgery..I don't think the medicine folks here look at fims before they are read-sometimes a couple of days later). We are getting a PACS system on monday. Hopefully things will improve somewhat.

But to directly address the point of the OP, a tech with many years of experience can probably tell you with a fair degree of accuracy what a study will be read as. I would venture that they would probably more reliably predict the right response than someone who is still training to actually read those types of studies, or someone who only recently completed training. Does that mean you should get rid of the rads, or the sleep medicine doc or whatever? No. It just means that experience is important.